Purpose: To conduct a prospective outcomes study describing use of Complementary and Alternative medicine (CAM), and integrated oncology (IO) and their effects on breast cancer patients in community settings. Background: Between 50% and 80% of women in the United States with breast cancer supplement their conventional medical treatment regimen with some form of CAM therapy. Most CAM use is self-prescribed and unsupervised, however, IO has matured into a set of science-based practices that warrant evaluation. IO clinics are directed by physicians, MDs, naturopathic physicians (NDs), and doctors of acupuncture and Oriental medicine (DAOM), who use best practices and evidence-based CAM to improve the health and well being of cancer patients who also receive standard conventional cancer therapy. This study will describe IO care as provided in community clinics and provide an initial evaluation of the effects of IO care and CAM use on breast cancer patients'Health Related Quality of Life (HRQOL). Hypothesis: IO services improve patients'quality of life and decrease cancer recurrence rates in breast cancer patients, as compared to women with similar disease states and prognoses who do not receive IO care, and may or may not use CAM treatment on their own. Methods: A partnership between Bastyr University and Fred Hutchinson Cancer Research Center will create a case-control matched cohort of IO using breast cancer patients and breast cancer patients with similar prognosis at time of diagnosis who did not use IO care and may or may not have used CAM on a self- prescription basis. This cohort will be followed prospectively allowing for a description of the outcomes of IO breast cancer care provided through a community IO clinic network in Seattle. Aims: 1) To describe the treatments received by breast cancer patients receiving physician level integrative oncology (IO) care from community clinics (cohort;n = 600) and the cost of IO care for breast cancer;2) To describe the Health Related Quality of Life (HRQOL) experienced by breast cancer patients receiving physician level Integrative Oncology (IO) care (cohort;n = 300) and that of a group of comparison women with breast cancer (cohort;n = 900) receiving conventional treatment with or without self-prescribed CAM (n = 400- 450 and n = 450-500). In addition to describing changes in HRQOL associated with IO and CAM use and estimating the effects attributable to IO or CAM use, 3) To collect pilot data on survival and disease free survival in outcomes at 2 and 3 years follow-up in a cohort of 300 IO breast cancer patients, and a matched comparison group of 900 who did not choose to use IO during their initial treatment for breast cancer. PUBLIC HEALTH RELEVANCE: The purpose of this five year project is to conduct a prospective matched controlled outcomes study that describes physician directed integrated oncology therapies and their effects on breast cancer patients'quality of life, cancer recurrence and survival rates for those who receive integrated oncology care in Seattle, Washington.